Expert Review on Contemporary Management of Common Benign Pleural Effusions

Abstract

Heart failure (HF) and cirrhosis are frequently associated with pleural effusions (PEs). Despite their apparently benign nature, both HF-related effusions and hepatic hydrothorax (HH) have poor prognosis because they represent an advanced stage of the disease. Optimization of medical therapy in these two entities involve not only the use of diuretics, but also other pharmacological therapies. For instance, all HF patients with reduced or mildly reduced left ventricular ejection fraction can benefit from angiotensin receptor–neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Conversely, it is better for HH patients to avoid nonselective beta blockers. Refractory cardiac- and cirrhosis-related PEs are commonly managed by iterative therapeutic thoracentesis. When repeated aspirations are needed, thereby diminishing quality of life, the insertion of an indwelling pleural catheter (IPC) may be warranted. However, in selected HH patients who are diuretic-resistant or diuretic-intractable, placement of transjugular intrahepatic portosystemic shunts should be considered as a bridge to liver transplantation, whereas in transplant candidates the role of IPC is debatable. Another benign condition, pleural tuberculosis (TB) is a serious health problem in developing countries. Diagnostic certainty is still a concern due to the paucibacillary nature of the infection, although the use of more sensitive nucleic acid amplification tests is becoming more widespread. Its treatment is the same as that of pulmonary TB, but the potential drug interactions between antiretroviral and anti-TB drugs in HIV-coinfected patients as well as the current recommended guidelines for the different types of anti-TB drugs resistance should be followed.

Keywords

pleural effusion - heart failure - tuberculous pleurisy - cirrhosis - portal hypertension - spontaneous bacterial empyema

Publikationsverlauf

Artikel online veröffentlicht:
01. Juni 2023

• References

• 1 Porcel JM, Esquerda A, Vives M, Bielsa S. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol 2014; 50 (05) 161-165
• 2 Markatis E, Perlepe G, Afthinos A. et al. Mortality among hospitalized patients with pleural effusions. a multicenter, observational, prospective study. Front Med (Lausanne) 2022; 9: 828783
• 3 Romero S, Lim AK, Singh G. et al. Natural history and outcomes of patients with liver cirrhosis complicated by hepatic hydrothorax. World J Gastroenterol 2022; 28 (35) 5175-5187
• 4 Matei D, Craciun R, Crisan D. et al. Hepatic hydrothorax-an independent decompensating event associated with long-term mortality in patients with cirrhosis. J Clin Med 2021; 10 (16) 3688
• 5 Osman KT, Abdelfattah AM, Mahmood SK, Elkhabiry L, Gordon FD, Qamar AA. Refractory hepatic hydrothorax is an independent predictor of mortality when compared to refractory ascites. Dig Dis Sci 2022; 67 (10) 4929-4938
• 6 Porcel JM. Nonmalignant pleural effusions. Semin Respir Crit Care Med 2022; 43 (04) 570-582
• 7 Porcel JM. Pleural effusions: post-surgical and post-cardiac injury. In: Janes SM. ed. Encyclopedia of Respiratory Medicine, Vol. 4. London, United Kingdom: Elsevier, Academic Press; 2022: 456-462
• 8 Bedawi EO, Ricciardi S, Hassan M. et al. ERS/ESTS statement on the management of pleural infection in adults. Eur Respir J 2023; 61 (02) 2201062
• 9 Botana Rial M, Pérez Pallarés J, Cases Viedma E. et al. Diagnosis and treatment of pleural effusion. recommendations of the Spanish Society of Pulmonology and Thoracic Surgery. Update 2022. Arch Bronconeumol 2023; 59 (01) 27-35
• 10 Morales-Rull JL, Bielsa S, Conde-Martel A. et al; RICA Investigators group. Pleural effusions in acute decompensated heart failure: prevalence and prognostic implications. Eur J Intern Med 2018; 52: 49-53
• 11 Lindner M, Thomas R, Claggett B. et al. Quantification of pleural effusions on thoracic ultrasound in acute heart failure. Eur Heart J Acute Cardiovasc Care 2020; 9 (05) 513-521
• 12 Porcel JM. Pleural effusions from congestive heart failure. Semin Respir Crit Care Med 2010; 31 (06) 689-697
• 13 de Araujo BS, Reichert R, Eifer DA. et al. Trepopnea may explain right-sided pleural effusion in patients with decompensated heart failure. Am J Emerg Med 2012; 30 (06) 925-931.e2
• 14 Porcel JM, Vives M. Etiology and pleural fluid characteristics of large and massive effusions. Chest 2003; 124 (03) 978-983
• 15 Porcel JM, Light RW. Pleural effusions. Dis Mon 2013; 59 (02) 29-57
• 16 Elgwairi E, Abdalla A, Elkheshen A, Elharabi Z, Nugent K. Pleural effusions in patients with congestive heart failure: frequency, pathogenesis, diagnosis, and implications. Cardiol Rev 2022; (e-pub ahead of print) DOI: 10.1097/CRD.0000000000000469.
• 17 Li H, Chen J, Hu PX. Cardiopulmonary ultrasound correlates of pleural effusions in patients with congestive heart failure. BMC Cardiovasc Disord 2022; 22 (01) 198
• 18 Bezgin T, Celik AI. Prognostic impact of small pericardial effusion in acute heart failure. Am J Med Sci 2022; 364 (06) 729-734
• 19 Chen HJ, Tu CY, Ling SJ. et al. Sonographic appearances in transudative pleural effusions: not always an anechoic pattern. Ultrasound Med Biol 2008; 34 (03) 362-369
• 20 Shkolnik B, Judson MA, Austin A. et al. Diagnostic accuracy of thoracic ultrasonography to differentiate transudative from exudative pleural effusion. Chest 2020; 158 (02) 692-697
• 21 Asciak R, Hassan M, Mercer RM. et al. Prospective analysis of the predictive value of sonographic pleural fluid echogenicity for the diagnosis of exudative effusion. Respiration 2019; 97 (05) 451-456
• 22 Soni NJ, Dreyfuss ZS, Ali S. et al. Pleural fluid echogenicity measured by ultrasound image pixel density to differentiate transudative versus exudative pleural effusions. Ann Am Thorac Soc 2022; 19 (05) 857-860
• 23 Wang T, Du G, Fang L, Bai Y, Liu Z, Wang L. Value of ultrasonography in determining the nature of pleural effusion: analysis of 582 cases. Medicine (Baltimore) 2022; 101 (33) e30119
• 24 Miger K, Fabricius-Bjerre A, Overgaard Olesen AS. et al. Chest computed tomography features of heart failure: a prospective observational study in patients with acute dyspnea. Cardiol J 2022; 29 (02) 235-244
• 25 Porcel JM, Bagüeste G, Pardina M, Sancho-Marquina P, Bielsa S. Computed tomography attenuation values of pleural fluid are useless for differentiating transudates from exudates. Span J Med. 2022; 2 (01) 24-27
• 26 Mercer RM, Corcoran JP, Porcel JM, Rahman NM, Psallidas I. Interpreting pleural fluid results. Clin Med (Lond) 2019; 19 (03) 213-217
• 27 Porcel JM, Light RW. Pleural fluid analysis: are light's criteria still relevant after half a century?. Clin Chest Med 2021; 42 (04) 599-609
• 28 Bielsa S, Porcel JM, Castellote J, Mas E, Esquerda A, Light RW. Solving the Light's criteria misclassification rate of cardiac and hepatic transudates. Respirology 2012; 17 (04) 721-726
• 29 Porcel JM. Identifying transudates misclassified by Light's criteria. Curr Opin Pulm Med 2013; 19 (04) 362-367
• 30 Porcel JM, Ferreiro L, Civit C. et al. Development and validation of a scoring system for the identification of pleural exudates of cardiac origin. Eur J Intern Med 2018; 50: 60-64
• 31 Porcel JM, Vives M, Cao G, Esquerda A, Rubio M, Rivas MC. Measurement of pro-brain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions due to heart failure. Am J Med 2004; 116 (06) 417-420
• 32 Porcel JM, Martínez-Alonso M, Cao G, Bielsa S, Sopena A, Esquerda A. Biomarkers of heart failure in pleural fluid. Chest 2009; 136 (03) 671-677
• 33 Han ZJ, Wu XD, Cheng JJ. et al. Diagnostic accuracy of natriuretic peptides for heart failure in patients with pleural effusion: a systematic review and updated meta-analysis. PLoS One 2015; 10 (08) e0134376
• 34 Behnoush AH, Khalaji A, Naderi N, Ashraf H, von Haehling S. ACC/AHA/HFSA 2022 and ESC 2021 guidelines on heart failure comparison. ESC Heart Fail 2022; (e-pub ahead of print) DOI: 10.1002/ehf2.14255.
• 35 Heidenreich PA, Bozkurt B, Aguilar D. et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79 (17) 1757-1780
• 36 Chan JSK, Kot TKM, Ng M, Harky A. Continuous infusion versus intermittent boluses of furosemide in acute heart failure: a systematic review and meta-analysis. J Card Fail 2020; 26 (09) 786-793
• 37 Trulls JC, Morales-Rull JL, Casado J. et al; CLOROTIC trial investigators. Combining loop with thiazide diuretics for decompensated heart failure: the CLOROTIC trial. Eur Heart J 2023; 44 (05) 411-421
• 38 Mullens W, Dauw J, Martens P. et al; ADVOR Study Group. Acetazolamide in acute decompensated heart failure with volume overload. N Engl J Med 2022; 387 (13) 1185-1195
• 39 Bueno Juana E, Gracia Gutiérrez A, Melero Polo J. et al. A descriptive study of transthyretin amyloidosis in a tertiary hospital without a referral unit. Rev Clin Esp (Barc) 2022; 222 (03) 161-168
• 40 Porcari A, Razvi Y, Masi A. et al. Prevalence, characteristics and outcomes of older patients with hereditary versus wild-type transthyretin amyloid cardiomyopathy. Eur J Heart Fail 2023; 25 (04) 515-524
• 41 Picken MM. Current understanding of systemic amyloidosis and underlying disease mechanisms. Am J Cardiol 2022; 185 (Suppl. 01) S2-S10
• 42 Di Lisi D, Di Stefano V, Brighina F, Galassi AR, Novo G. Therapy of ATTR cardiac amyloidosis: current indications. Curr Probl Cardiol 2023; 48 (02) 101487
• 43 Lazarevic A, Dobric M, Goronja B. et al. Lung ultrasound-guided therapeutic thoracentesis in refractory congestive heart failure. Acta Cardiol 2020; 75 (05) 398-405
• 44 Fong C, Tan CWC, Tan DKY, See KC. Safety of thoracentesis and tube thoracostomy in patients with uncorrected coagulopathy: a systematic review and meta-analysis. Chest 2021; 160 (05) 1875-1889
• 45 Patil M, Dhillon SS, Attwood K, Saoud M, Alraiyes AH, Harris K. Management of benign pleural effusions using indwelling pleural catheters: a systematic review and meta-analysis. Chest 2017; 151 (03) 626-635
• 46 Matta A. Indwelling pleural catheters for benign pleural effusions: a concise review. Curr Opin Pulm Med 2023; 29 (01) 37-42
• 47 Porcel JM, Torres M, Pardina M, Civit C, Salud A, Bielsa S. Predictors of indwelling pleural catheter removal and infection: a single-center experience with 336 procedures. J Bronchology Interv Pulmonol 2020; 27 (02) 86-94
• 48 Wang S, Zhang R, Wan C. et al. Incidence of complications from indwelling pleural catheter for pleural effusion: a meta-analysis. Clin Transl Sci 2023; 16 (01) 104-117
• 49 Walker SP, Bintcliffe O, Keenan E. et al. Randomised trial of indwelling pleural catheters for refractory transudative pleural effusions. Eur Respir J 2022; 59 (02) 2101362
• 50 Gilbert CR, Porcel JM. Management of recurrent transudative pleural effusions: can we REDUCE unnecessary interventions?. Eur Respir J 2022; 59 (02) 2101942
• 51 World Health Organization. Global Tuberculosis Report 2022. Geneva: World Health Organization; 2022
• 52 Ferreiro L, Ruano-Raviña A, Otero-Mallo R. et al. Recent epidemiological trends in extrapulmonary TB in Galicia, Spain. Int J Tuberc Lung Dis 2021; 25 (05) 373-381
• 53 Li L, Lv Y, Su L. et al. Epidemiology of extrapulmonary tuberculosis in central Guangxi from 2016 to 2021. Eur J Clin Microbiol Infect Dis 2023; 42 (02) 129-140
• 54 Porcel JM. Tuberculous pleural effusion. Lung 2009; 187 (05) 263-270
• 55 Bielsa S, Acosta C, Pardina M, Civit C, Porcel JM. Tuberculous pleural effusion: clinical characteristics of 320 patients. Arch Bronconeumol (Engl Ed) 2019; 55 (01) 17-22
• 56 Shimoda M, Hirata A, Tanaka Y. et al. Characteristics of pleural effusion with a high adenosine deaminase level: a case-control study. BMC Pulm Med 2022; 22 (01) 359
• 57 Porcel JM, Alemán C, Bielsa S, Sarrapio J, Fernández de Sevilla T, Esquerda A. A decision tree for differentiating tuberculous from malignant pleural effusions. Respir Med 2008; 102 (08) 1159-1164
• 58 Ko JM, Park HJ, Kim CH. Pulmonary changes of pleural TB: up-to-date CT imaging. Chest 2014; 146 (06) 1604-1611
• 59 Porcel JM. Pearls and myths in pleural fluid analysis. Respirology 2011; 16 (01) 44-52
• 60 Porcel JM. Biomarkers in the diagnosis of pleural diseases: a 2018 update. Ther Adv Respir Dis 2018; 12: 1753466618808660
• 61 Bielsa S, Palma R, Pardina M, Esquerda A, Light RW, Porcel JM. Comparison of polymorphonuclear- and lymphocyte-rich tuberculous pleural effusions. Int J Tuberc Lung Dis 2013; 17 (01) 85-89
• 62 World Health Organization. Manual for selection of molecular WHO-recommended rapid diagnostic tests for detection of tuberculosis and drug-resistant tuberculosis. Geneva: World Health Organization; 2022
• 63 Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Xpert MTB/RIF Ultra versus Xpert MTB/RIF for diagnosis of tuberculous pleural effusion: a systematic review and comparative meta-analysis. PLoS One 2022; 17 (07) e0268483
• 64 Akhter N, Sumalani KK, Chawla D, Ahmed Rizvi N. Comparison between the diagnostic accuracy of Xpert MTB/Rif assay and culture for pleural tuberculosis using tissue biopsy. ERJ Open Res 2019; 5 (03) 00065-02019
• 65 Li C, Liu C, Sun B. et al. Performance of Xpert MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy. BMC Infect Dis 2020; 20 (01) 840
• 66 Sun W, Zhou Y, Li W. et al. Diagnostic yield of Xpert MTB/RIF on contrast-enhanced ultrasound-guided pleural biopsy specimens for pleural tuberculosis. Int J Infect Dis 2021; 108: 89-95
• 67 Bielsa S, Bernet A, Civit C, Acosta C, Manonelles A, Porcel JM. FluoroType MTB in pleural fluid for diagnosing tuberculosis. Rev Clin Esp (Barc) 2021; 221 (03) 139-144
• 68 Porcel JM. Advances in the diagnosis of tuberculous pleuritis. Ann Transl Med 2016; 4 (15) 282
• 69 Aggarwal AN, Agarwal R, Sehgal IS, Dhooria S. Adenosine deaminase for diagnosis of tuberculous pleural effusion: a systematic review and meta-analysis. PLoS One 2019; 14 (03) e0213728
• 70 Kim HW, Kim KH, Shin AY. et al. Investigating the appropriate adenosine deaminase cutoff value for the diagnosis of tuberculous pleural effusion in a country with decreasing TB burden. Sci Rep 2022; 12 (01) 7586
• 71 Porcel JM, Esquerda A, Bielsa S. Diagnostic performance of adenosine deaminase activity in pleural fluid: a single-center experience with over 2100 consecutive patients. Eur J Intern Med 2010; 21 (05) 419-423
• 72 Jiang CG, Wang W, Zhou Q. et al. Influence of age on the diagnostic accuracy of soluble biomarkers for tuberculous pleural effusion: a post hoc analysis. BMC Pulm Med 2020; 20 (01) 178
• 73 Palma RM, Bielsa S, Esquerda A, Martínez-Alonso M, Porcel JM. Diagnostic accuracy of pleural fluid adenosine deaminase for diagnosing tuberculosis. meta-analysis of Spanish studies. Arch Bronconeumol (Engl Ed) 2019; 55 (01) 23-30
• 74 Zeng T, Ling B, Hu X. et al. The value of adenosine deaminase 2 in the detection of tuberculous pleural effusion: a meta-analysis and systematic review. Can Respir J 2022; 2022: 7078652
• 75 Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Unstimulated pleural fluid interferon gamma for diagnosis of tuberculous pleural effusion: a systematic review and meta-analysis. J Clin Microbiol 2021; 59 (05) e02112-e02120
• 76 Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Comparative accuracy of pleural fluid unstimulated interferon-gamma and adenosine deaminase for diagnosing pleural tuberculosis: a systematic review and meta-analysis. PLoS One 2021; 16 (06) e0253525
• 77 Luo Y, Yan F, Xue Y. et al. Diagnostic utility of pleural fluid T-SPOT and interferon-gamma for tuberculous pleurisy: a two-center prospective cohort study in China. Int J Infect Dis 2020; 99: 515-521
• 78 Tong X, Li Z, Zhao J, Liu S, Fan H. The value of single or combined use of pleural fluid interferon gamma release assay in the diagnosis of tuberculous pleurisy. Trop Med Int Health 2021; 26 (11) 1356-1366
• 79 Luo Y, Xue Y, Guo X. et al. Diagnostic value of pleural fluid T-SPOT for tuberculous pleurisy: an updated meta-analysis. Tuberculosis (Edinb) 2020; 122: 101941
• 80 Hofland RW, Bossink AW, Lammers JW, Thijsen SF. Pleural fluid and tuberculosis: are all interferon gamma release assays equal?. J Clin Microbiol 2016; 54 (02) 504-505
• 81 Aggarwal AN, Agarwal R, Dhooria S, Prasad KT, Sehgal IS, Muthu V. Pleural fluid interleukins for diagnosis of tuberculous pleural effusion: a systematic review and meta-analysis. Cytokine 2022; 159: 156019
• 82 Zhang Q, Ma Y, Zhang M, Wang Y, Wu W. Diagnostic accuracy of interleukin-27 in tuberculous pleurisy: a systematic review and meta-analysis. QJM 2021; 114 (08) 568-576
• 83 Pereyra MF, San-José E, Ferreiro L. et al. Role of blind closed pleural biopsy in the managment of pleural exudates. Can Respir J 2013; 20 (05) 362-366
• 84 Zhang Y, Tang J, Zhou X, Zhou D, Wang J, Tang Q. Ultrasound-guided pleural cutting needle biopsy: accuracy and factors influencing diagnostic yield. J Thorac Dis 2018; 10 (06) 3244-3252
• 85 Zhang T, Wan B, Wang L. et al. The diagnostic yield of closed needle pleural biopsy in exudative pleural effusion: a retrospective 10-year study. Ann Transl Med 2020; 8 (07) 491
• 86 Edgar JR, Wong ML, Hale M, Menezes CN. Histopathological diagnoses on pleural biopsy specimens over a 15-year period at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa: a retrospective review. S Afr Med J 2018; 109 (01) 53-57
• 87 Sahn SA, Huggins JT, San José ME, Álvarez-Dobaño JM, Valdés L. Can tuberculous pleural effusions be diagnosed by pleural fluid analysis alone?. Int J Tuberc Lung Dis 2013; 17 (06) 787-793
• 88 Lee J, Park S, Park JE. et al. Etiological distribution and morphological patterns of granulomatous pleurisy in a tuberculosis-prevalent country. J Korean Med Sci 2021; 36 (01) e10
• 89 Aydogan Eroglu S, Yildiz T, Sonkaya E. et al. Diagnosis distribution in cases with granulomatous inflammation in lung, pleura, and lymph node biopsies: an experience from a tertiary level single center chest diseases and thoracic surgery hospital. Sarcoidosis Vasc Diffuse Lung Dis 2022; 38 (04) e2021048
• 90 Shaw JA, Koegelenberg CFN. Pleural tuberculosis. Clin Chest Med 2021; 42 (04) 649-666
• 91 Akkerman OW, Duarte R, Tiberi S. et al. Clinical standards for drug-susceptible pulmonary TB. Int J Tuberc Lung Dis 2022; 26 (07) 592-604
• 92 Gandhi RT, Bedimo R, Hoy JF. et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2022 recommendations of the International Antiviral Society-USA panel. JAMA 2023; 329 (01) 63-84
• 93 Mendioroz J, Pequeño S, López M, Martínez H, Sicart E. La tuberculosi a Catalunya l'any 2020. Subdirecció General de Vigilància i Reposta a Emergències de Salut Pública: Department de Salut, Generalitat de Catalunya; 2022
• 94 World Health Organization. WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment, 2022 update. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO
• 95 Porcel JM. Persistent benign pleural effusion. Rev Clin Esp (Barc) 2017; 217 (06) 336-341
• 96 Porcel JM, Rubio-Caballero M. Secuelas del derrame pleural tuberculoso. [Sequelae of tuberculous pleural effusion] Med Clín (Barc) 2005; 124 (13) 494-496
• 97 Lai YF, Su MC, Weng HH, Wu JT, Chiu CT. Sonographic septation: a predictor of sequelae of tuberculous pleurisy after treatment. Thorax 2009; 64 (09) 806-809
• 98 Lai YF, Chao TY, Wang YH, Lin AS. Pigtail drainage in the treatment of tuberculous pleural effusions: a randomised study. Thorax 2003; 58 (02) 149-151
• 99 Bhuniya S, Arunabha DC, Choudhury S, Saha I, Roy TS, Saha M. Role of therapeutic thoracentesis in tuberculous pleural effusion. Ann Thorac Med 2012; 7 (04) 215-219
• 100 Ryan H, Yoo J, Darsini P. Corticosteroids for tuberculous pleurisy. Cochrane Database Syst Rev 2017; 3 (03) CD001876
• 101 Xie S, Lu L, Li M. et al. The efficacy and safety of adjunctive corticosteroids in the treatment of tuberculous pleurisy: a systematic review and meta-analysis. Oncotarget 2017; 8 (47) 83315-83322
• 102 Porcel JM, Mas E, Reñé JM, Bielsa S. Hidrotórax de causa hepática: análisis de 77 pacientes. [Hepatic hydrothorax: report of a series of 77 patients] Med Clín (Barc) 2013; 141 (11) 484-486
• 103 Ma B, Shang T, Huang J. et al. Analysis of clinical features and prognostic factors in patients with hepatic hydrothorax: a single-center study from China. BMC Gastroenterol 2022; 22 (01) 333
• 104 Rendón-Ramírez EJ, González-Villarreal M, Muñoz-Espinoza LE. et al. Pleural effusions identified by point-of-care ultrasound predict poor outcomes in decompensated cirrhosis. Ultrasound Med Biol 2021; 47 (11) 3283-3290
• 105 Jindal A, Mukund A, Kumar G, Sarin SK. Efficacy and safety of transjugular intrahepatic portosystemic shunt in difficult-to-manage hydrothorax in cirrhosis. Liver Int 2019; 39 (11) 2164-2173
• 106 Mücke VT, Fitting D, Dultz G. et al. Application of contrast-enhanced ultrasound to detect hepatic hydrothorax in patients with liver cirrhosis. Ultraschall Med 2022; 43 (05) 473-478
• 107 Aithal GP, Palaniyappan N, China L. et al. Guidelines on the management of ascites in cirrhosis. Gut 2021; 70 (01) 9-29
• 108 Porcel JM. Management of refractory hepatic hydrothorax. Curr Opin Pulm Med 2014; 20 (04) 352-357
• 109 Albillos A, Krag A. Beta-blockers in the era of precision medicine in patients with cirrhosis. J Hepatol 2023; 78 (04) 866-872
• 110 Téllez L, Guerrero A, Albillos A. Update on the diagnosis and management of portal hypertension in cirrhosis according to the Baveno VII Consensus Conference recommendations. Rev Esp Enferm Dig 2022; 114 (09) 534-542
• 111 Kulkarni AV, Sharma M, Kumar P, Gupta R, Rao PN. Letter to the editor: midodrine for hepatic hydrothorax. Hepatology 2021; 73 (03) 1236-1237
• 112 Shojaee S, Khalid M, Kallingal G, Kang L, Rahman N. Repeat thoracentesis in hepatic hydrothorax and non-hepatic hydrothorax effusions: a case-control study. Respiration 2018; 96 (04) 330-337
• 113 Ridha A, Al-Abboodi Y, Fasullo M. The outcome of thoracentesis versus chest tube placement for hepatic hydrothorax in patients with cirrhosis: a nationwide analysis of the national inpatient sample. Gastroenterol Res Pract 2017; 2017: 5872068
• 114 Hung TH, Tseng CW, Tsai CC, Hsieh YH, Tseng KC, Tsai CC. Mortality following catheter drainage versus thoracentesis in cirrhotic patients with pleural effusion. Dig Dis Sci 2017; 62 (04) 1080-1085
• 115 Gou X, Jia W, He C. et al. Hepatic hydrothorax does not increase the risk of death after transjugular intrahepatic portosystemic shunt in cirrhosis patients. Eur Radiol 2022; 33 (05) 3407-3415
• 116 Boike JR, Thornburg BG, Asrani SK. et al; Advancing Liver Therapeutic Approaches (ALTA) Consortium. North American practice-based recommendations for transjugular intrahepatic portosystemic shunts in portal hypertension. Clin Gastroenterol Hepatol 2022; 20 (08) 1636-1662.e36
• 117 Ditah IC, Al Bawardy BF, Saberi B, Ditah C, Kamath PS. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: a systematic review and cumulative meta-analysis. World J Hepatol 2015; 7 (13) 1797-1806
• 118 Will V, Rodrigues SG, Berzigotti A. Current treatment options of refractory ascites in liver cirrhosis - a systematic review and meta-analysis. Dig Liver Dis 2022; 54 (08) 1007-1014
• 119 Gilbert CR, Shojaee S, Maldonado F. et al. Pleural interventions in the management of hepatic hydrothorax. Chest 2022; 161 (01) 276-283
• 120 Avula A, Acharya S, Anwar S. et al. Indwelling pleural catheter (IPC) for the management of hepatic hydrothorax: the known and the unknown. J Bronchology Interv Pulmonol 2022; 29 (03) 179-185
• 121 Hou F, Qi X, Guo X. Effectiveness and safety of pleurodesis for hepatic hydrothorax: a systematic review and meta-analysis. Dig Dis Sci 2016; 61 (11) 3321-3334
• 122 Huang PM, Kuo SW, Chen JS, Lee JM. Thoracoscopic mesh repair of diaphragmatic defects in hepatic hydrothorax: a 10-year experience. Ann Thorac Surg 2016; 101 (05) 1921-1927
• 123 Hung TH, Tseng CW, Tsai CC, Tsai CC, Tseng KC, Hsieh YH. The long-term outcomes of cirrhotic patients with pleural effusion. Saudi J Gastroenterol 2018; 24 (01) 46-51
• 124 Osman KT, Mehta N, Spencer C, Qamar AA. Spontaneous bacterial empyema: a tertiary care center experience and a systematic review. Expert Rev Gastroenterol Hepatol 2022; 16 (05) 487-492
• 125 Albitar HAH, Iyer V, Nelson DR, Kern RM, Leise M, Gallo De Moraes A. Early thoracentesis correlated with survival benefit in patients with spontaneous bacterial empyema. Dig Liver Dis 2022; 54 (08) 1015-1020
• 126 Faust N, Yamada A, Haider H. et al. Systemic review and network meta-analysis: Prophylactic antibiotic therapy for spontaneous bacterial peritonitis. World J Hepatol 2020; 12 (05) 239-252
• 127 Praharaj DL, Premkumar M, Roy A. et al. Rifaximin vs. norfloxacin for spontaneous bacterial peritonitis prophylaxis: a randomized controlled trial. J Clin Exp Hepatol 2022; 12 (02) 336-342
• 128 Bintcliffe OJ, Hooper CE, Rider IJ. et al. Unilateral pleural effusions with more than one apparent etiology. a prospective observational study. Ann Am Thorac Soc 2016; 13 (07) 1050-1056
• 129 Bhatnagar R, Keenan EK, Morley AJ. et al. Outpatient talc administration by indwelling pleural catheter for malignant effusion. N Engl J Med 2018; 378 (14) 1313-1322
• 130 Peddle-McIntyre CJ, Muruganandan S, McVeigh J. et al. Device assessed activity behaviours in patients with indwelling pleural catheter: a sub-study of the Australasian Malignant PLeural Effusion (AMPLE)-2 randomized trial. Respirology 2023; (e-pub ahead of print) DOI: 10.1111/resp.14451.